To amend title XVIII of the Social Security Act to establish a demonstration program to promote collaborative treatment of mental and physical health comorbidities under the Medicare program.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
This bill creates a five-year Medicare demonstration program (2025-2030) to test new approaches for treating people who have both mental health conditions and chronic physical illnesses. The program focuses on safety-net hospitals serving vulnerable communities and aims to integrate mental health care with physical health care while addressing social factors like food insecurity and housing.
Who Benefits and How
Safety-net hospitals (rural hospitals, large teaching hospitals, and urban safety-net hospitals with high percentages of low-income patients) benefit by receiving federal payments to implement innovative care programs. Low-income individuals with mental and physical health comorbidities who are on Medicare, Medicaid, or uninsured benefit from improved integrated care. Community health workers, social workers, and care coordinators may see increased employment opportunities as hospitals implement wrap-around services.
Who Bears the Burden and How
Participating hospitals must submit detailed plans, track extensive quality metrics, and participate in a learning collaborative - creating administrative requirements. The program uses existing appropriations under Section 1115A(f) of the Social Security Act, so no new federal appropriation is required, but it directs existing funds to this specific purpose.
Key Provisions
- Creates a voluntary demonstration program for eligible hospitals to test innovations in treating mental/physical health comorbidities
- Requires participating hospitals to address social determinants of health (nutrition, housing, employment support)
- Establishes a learning collaborative to share best practices among participating hospitals
- Mandates a congressional report evaluating program outcomes within one year of completion
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Establishes a Medicare demonstration program to test and evaluate innovations in treating individuals with co-occurring mental and physical health conditions at safety-net hospitals in vulnerable communities.
Key Policy Areas
Healthcare, Mental Health, Medicare, Social Determinants of Health
Primary Purpose
Establishes a Medicare demonstration program to test and evaluate innovations in treating individuals with co-occurring mental and physical health conditions at safety-net hospitals in vulnerable communities.
Policy Domains
Demonstration Program for Mental and Physical Health Comorbidities
Identified Gains
Contextual inference, no direct clause citation- Safety-net hospitals
- Low-income patients with comorbidities
- Healthcare workers in care coordination
- Community health organizations
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Participating hospitals (administrative compliance)
- Federal government (funding from existing appropriations)
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMr. Boyle of Pennsylvania (for himself and Ms. Brown) introduced …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Care coordinators and social workers, Participating hospitals (administrative burden), Safety-net hospitals (rural, teaching, urban DSH hospitals)
Positive-direction: Care coordinators and social workers, Safety-net hospitals (rural, teaching, urban DSH hospitals)
Negative-direction: Participating hospitals (administrative burden)
Federally qualified health centers and rural health clinics
Low-income individuals with mental and physical health comorbidities
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
An individual with mental and physical health comorbidities who is a Medicare subsidy eligible individual, enrolled under Medicaid, or uninsured.
A rural hospital with disproportionate patient percentage of at least 35%, a large teaching/tertiary hospital with 200+ beds and high case mix index, or a small urban safety net hospital with less than 200 beds deemed a disproportionate share hospital.
Innovations that promote holistic care and treatment of co-occurring mental and physical health comorbidities, including interdisciplinary care teams, integration of mental health into medical homes, EHR improvements, and health behavior interventions.
Innovations addressing social factors that negatively impact health outcomes, including EHR improvements for social care integration, wrap-around services, home and community-based services, and hospital-based interventions.
An individual with serious mental illness or serious emotional disturbance plus one or more of: chronic conditions, high-risk pregnancy, high utilization of acute care, frail elderly status, disability, or critical illness/injury.
A geographic area served by an eligible hospital with significant numbers of individuals with mental and physical health comorbidities, poor population health indicators, low-income status, or food desert designation.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology